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To the Editor:Neisseria gonorrhoeae is a common etiologic agent of pelvic inflammatory disease (PID).1 The development of PID is likely determined by both host susceptibility and the virulence of the organism, and there is clinical evidence that changes in host susceptibility are influenced by hormonal status. For instance, the incidence of gonococcal PID symptoms is highest during the early proliferative phase of the menstrual cycle, and PID is less prevalent among women who use oral contraceptives.1 - 4 Furthermore, men rarely develop ascending gonococcal infections. Since complement activity is an important defense against PID,5 we wanted to determine if complement activity is cyclic and thus correlated with resistance to gonococcal infection.
To investigate possible cyclic changes in serum properties, we evaluated the antibacterial activity of multiple serum samples obtained from 4 female volunteers, aged 25 to 35 years, at different phases of the menstrual cycle. All women had regular 28-day cycles, had no history of sexually transmitted disease, and were not receiving oral contraceptives. A pooled serum sample from 10 male volunteers (purchased from Sigma, St Louis, Mo) was also evaluated. Each serum sample was evaluated for the elimination of N gonorrhoeae strain 2005. The functional state of the complement system of each serum sample was assessed by the standard method of measuring total complement hemolytic activity (CH50).6
The antigonococcal effect of the serum was weakest at the early proliferative phase for all 4 women (Figure 1). The highest antigonococcal activity of serum was observed during the midcycle. Interestingly, CH50 was lowest in the early proliferative phase and highest at midcycle, paralleling the changes in antigonococcal activity. Male serum samples showed 55% bactericidal activity and had an average CH50 level of 125 U/mL.
CH50 indicates total complement hemolytic activity. Subjects were healthy women aged 25 to 35 years with regular 28-day menstrual cycles and without history of sexually transmitted disease. Each data point represents the average serum results from 4 subjects, each of whom provided serum at days 1, 7, 14, 21, and 28 of 3 separate menstrual cycles. Each sample was tested 3 times. Error bars represent SEM. The t test showed a statistically significant difference (P<.005) between day 1 and day 14.
We have demonstrated that both complement function and antibacterial activity of serum change cyclically in women, suggesting that sex hormones are involved in systemic immune function. It is possible that the physiologic decrease in complement function during menstruation may be a window of opportunity for N gonorrhoeae to colonize, invade, and cause ascending infection. These cyclic changes in host defense may be important not only in PID, but also in the pathogenesis of other infectious diseases in women. Further understanding of the link between the menstrual cycle and changes in host defense may generate novel strategies to prevent PID.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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